What drives it:

How to improve it:

Two lessons stand out. In this example, the dollar-based denial rate is higher than the count-based rate because a few denied surgical claims carry large balances. And if $500,000 of that gross A/R is personal-injury balances waiting on settlements, those accounts alone contribute 5 of the 38 days.

A benchmark is only useful when you know how it was calculated. Many revenue cycle “benchmarks” that circulate online have no source, no definition and no date. This guide gives the standard definition and formula for four core metrics, the targets that published sources actually state, and the orthopedic factors that can make your numbers look better or worse than they are.

Where a formal definition exists, we follow HFMA’s MAP Keys, which HFMA says apply to physician organizations as well as hospitals. Where only rules of thumb exist, we say so and name who states them.

Which RCM benchmarks should an orthopedic practice track?

Start with four metrics: days in A/R, clean claim rate, denial rate and net collection rate. Together they show how fast you get paid, how often claims go out right the first time, how often payers say no, and how much collectible revenue you keep.

None of these targets is an orthopedic median. MGMA’s DataDive and the AAOE Benchmarking Survey report specialty data to subscribers and participants. The public figures we could verify are below.

How do you calculate days in A/R, and what is a good number?

Days in A/R converts receivables into time. MGMA describes it as total A/R divided by average daily charges, which shows how many days pass between the date of service and payment. There are two valid versions, and you should never mix them:

• Gross days in A/R: gross A/R ÷ average daily gross charges. MGMA and AAOE both divide total A/R by a year of gross charges divided by 365.

• Net days in A/R: net A/R ÷ average daily net revenue. HFMA’s MAP Key FM-1 uses net A/R (after credit balances and expected contractual and bad-debt allowances) and the daily average of net patient service revenue for the most recent three months.

Dividing net A/R by gross daily charges produces a flattering number that means nothing.

The AAFP gives the clearest published target: keep days in A/R below 50 at minimum, with 30 to 40 days preferable. That is general practice-management guidance, not an orthopedic median. Direction matters too. In a July 28, 2026 MGMA Stat poll (203 responses), 32% of practice leaders said days in A/R were higher than a year earlier, 43% about the same and 22% lower.

Watch aging as well. HFMA’s MAP Key AR-1 ages billed A/R from the date of service into 0–30, 31–60, 61–90, 91–120 and over-120-day buckets, and MGMA uses the same buckets. The AAFP warns that a good overall number can hide old receivables, so track the share over 120 days.

What drives it: charge lag (days from visit or surgery to claim), front-end errors, denials and rework, payer mix and patient balances.

How to improve it: MGMA suggests running aging by payer, expecting clinicians to close encounters within 72 hours and staff to post charges within two days, and working denials daily, starting with high-dollar claims and the nearest appeal deadlines. Watch filing limits, too: Medicare requires claims within one calendar year of the date of service.

What clean claim rate should you target?

HFMA’s MAP Key CL-1 (Clean Claim Rate) divides the number of claims that pass edits requiring no manual intervention by the number of claims accepted into the claims processing tool for billing. Each claim is counted the first time it is scrubbed, including secondary and tertiary claims. It is a pre-submission measure, so it is not the same as payer acceptance or first-pass payment.

There is no formal published benchmark. In a November 2024 MGMA article on managing revenue cycle vendors, a consultant noted that a 90% clean claims rate is generally considered industry best practice. Guests from a revenue cycle vendor on an April 2025 MGMA podcast put the ideal at around 95%, a figure widely repeated in vendor materials.

Treat 90% to 95% or higher as a rule of thumb. In Experian Health’s 2025 State of Claims survey, 68% of providers said submitting clean claims was harder than a year earlier.

What drives it: registration and eligibility errors, missing authorizations, coding and modifier edits, and missing documentation. Edits orthopedic claims can trip include NCCI procedure-to-procedure pairs, unit limits and modifiers tied to global periods.

How to improve it: rank scrubber edits by volume and fix the top causes upstream, verify eligibility and authorization before the visit or surgery, and keep payer rules current. Read it alongside denial rate, because a stricter scrubber can lower your clean claim rate while preventing denials.

What is a normal denial rate in 2026?

First decide what you are counting:

• By count: HFMA’s MAP Key AR-5 (Remittance Denial Rate) divides total claims denied by total claims remitted, at the claim level. It includes initial and appeal denials and excludes patient-responsibility denials, duplicate claims and RAC recoupments. MGMA’s survey asks for the percentage of claims denied on first submission.

• By dollars: the AAFP divides the dollar amount of claims denied by the dollar amount submitted in the same period.

• Final denials: HFMA’s MAP Key AR-6 divides net dollars written off as denials by average monthly net patient service revenue.

Public figures vary because populations and methods differ:

• MGMA’s 2023 DataDive Practice Operations data showed a single-specialty aggregate of 8% of claims denied on first submission, the same rate as in 2019.

• Kodiak Solutions reported that payers initially denied 11.81% of claims in 2024, up from 11.53% in 2023, using data from more than 2,100 hospitals and 300,000 physicians on its platform. It combines hospital and physician data, so it is not an orthopedic benchmark.

• In its March 2026 release, Kodiak reported that the median final denial rate across more than 2,300 hospitals rose from 2.5% in 2024 to 2.7% in 2025.

• In Experian Health’s 2025 survey of 250 healthcare professionals, 41% said their organizations face denial rates of 10% or higher.

The AAFP calls 5% to 10% the industry average and says below 5% is more desirable. In a January 6, 2026 MGMA Stat poll (288 responses), 48% of practice leaders named denials and appeals as their biggest revenue cycle leak. The causes respondents described included medical necessity, bundling and global-package edits, and eligibility.

How to improve it: group denials by CARC and RARC code and by root cause, fix eligibility and authorization at the front end, close documentation gaps that drive medical-necessity denials, and track how often appeals succeed.

What net collection rate is realistic for orthopedics?

The net collection rate, also called the adjusted collection rate, divides payments by charges minus contractual adjustments. The AAFP’s formula is payments (net of credits) divided by charges (net of approved contractual adjustments) for the selected period, times 100. MGMA’s equivalent is the adjusted fee-for-service collection percentage. HFMA’s MAP Keys have no net collection rate; the closest is FM-2, cash collected as a percentage of average monthly net patient service revenue.

Because payments trail charges, use a lag, such as charges from January through June against payments posted through September, and keep the window the same each time. The gross collection rate (payments ÷ gross charges) depends heavily on how high you set your fee schedule, so it says little about billing performance.

The AAFP says the adjusted collection rate should be at least 95%, with 95% to 99% average and top performers at 99% or more. The one public orthopedic figure we found is lower: AAOE reports that the average net collection ratio (net collections ÷ net charges) among practices in its survey fell from 90.3% in 2020 to 86.8% in 2024. Definitions and timing may explain part of that gap, so compare only like with like.

What drives it: denial write-offs, timely-filing losses, missed underpayments, bad debt, and adjustments posted to the wrong code. Posting a denial write-off as a contractual adjustment shrinks the denominator and inflates the rate.

How to improve it: load contracted fee schedules so underpayments surface, limit who can post write-offs, and review adjustment codes monthly.

What do these metrics look like in a five-surgeon practice?

The numbers below are invented and rounded for illustration. Assume a 90-day quarter with $9,000,000 in gross charges ($100,000 a day) and $5,400,000 in contractual adjustments, leaving $3,600,000 in net charges ($40,000 a day).

Two lessons stand out. In this example, the dollar-based denial rate is higher than the count-based rate because a few denied surgical claims carry large balances. And if $500,000 of that gross A/R is personal-injury balances waiting on settlements, those accounts alone contribute 5 of the 38 days.

Why do orthopedic metrics look different from other specialties?

Workers’ compensation and personal injury

AAOE’s survey tracks workers’ compensation and legal/IME as separate payer classes, and for good reason. Workers’ comp follows state rules; Texas, for example, requires carriers to take final action on a complete medical bill within 45 days. Care under a personal-injury letter of protection is paid from a future judgment or settlement, which is how Florida law defines the arrangement, so those balances can age past 120 days by design. Report both separately; our workers’ comp billing guide covers the details.

Surgical global periods

Medicare’s 90-day global surgical package spans 92 days: the day before surgery, the day of surgery and the 90 days after. Related follow-up visits are paid as part of the surgery, so charges arrive in surgical spikes. Practitioners in groups of 10 or more in nine states must report those visits for certain procedures with 99024, a code that tracks a related post-op visit without separate payment. Decide whether these zero-charge claims count in your clean claim and denial denominators, because including them can make both rates look better.

DME and bracing

For Medicare, DMEPOS items such as braces are billed to a DME MAC, not your Part B MAC. To bill them, a practice must enroll as a DMEPOS supplier, which requires accreditation and a surety bond unless an exemption applies. If your DME claims are lower-dollar than your surgical claims, DME denials will move count-based rates more than dollar-based ones, so track DME as its own line.

Implants

When surgery happens in an ambulatory surgery center, Medicare packages implanted prosthetic devices into the facility payment and pays devices with pass-through status separately. If your group owns an ASC, report facility and professional metrics separately, because a handful of high-dollar device lines can swing dollar-based denial rates and A/R.

How should you use these benchmarks?

Write down your definitions, calculate every metric the same way each month, and trend a rolling three-month view. Segment by payer class and by professional, DME and facility claims before comparing yourself with anyone. If you buy specialty data from MGMA or AAOE, match their formulas first.

If you are weighing a change in billing model, require any vendor to report these four metrics using your definitions. Our comparison of in-house, outsourced and AI-automated billing includes a vendor checklist.